MCTD WITH LARGE VASCULITIC ULCERS- A THERAPEUTIC DILEMMA

PRESENTATION OF CASE A 37 years old female, a homemaker, residing in Navi Mumbai, came with chief complaints of multiple painful, reddish black skin lesions with blisters since 2 days, fever since 15 days, ulcer over fingertips since 3 months, tightening of skin over face since 3 months. Patient was apparently alright about 3 months before when she first presented to us with complaints of bluish discoloration of her fingers on exposure to cold. On rewarming, the fingers used to become normal. This was followed by development of small ulcers over the fingertips, which later healed with stellate scars. About 3 months ago, she developed pain in the knee joints. The pain subsided temporarily by the analgesics prescribed by the local practitioner. She also developed swelling of hands and feet and tightening of her facial skin. About 15 days ago, she developed fever. It was of high grade and continuous type, subsiding temporarily with antipyretics. After a few days following the onset of fever she developed painful, reddishblack skin discoloration of skin over the left hand dorsum, right elbow and forearm and the right calf area. The painful discoloration rapidly increased in size and developed reddish fluid filled blisters. There was history of decreased appetite and weight loss. There was no history of photosensitivity, difficulty in swallowing, breathing or other systemic involvement. There was no history suggestive of any neurological or musculoskeletal impairment and urinary bladder disturbance. Past history was not significant. There was no history of drug allergy, medical or surgical illness. Menstrual history -3/28 days regular menstrual cycle. Attained menarche at the age of 17 years of age. Obstetric historyShe has three children, all were full-term normal deliveries without any complications. She did not have any history of abortions.